Given your previous experience and your own description of what you are perceiving hospice to be, I would strongly suggest working in an inpatient hospice unit first. And IMHO you can go ahead and apply now. If you are highly motivated and
a quick study, working in an IPU should be doable. In starting in an IPU you will be around other nurses so that you ask questions (not so in homecare), you will be in closer contact with the attending physician (not so in homecare), you will have a charge nurse/clinical resource (not so in homecare), and you will get to see a variety of clinical pictures simultaneously that will provide you with a much better base for assessing terminally ill or actively dying pts and giving palliative pharmacological care (not so in home care), as well as learning the meds (via formulary or MUGS etc.) so common to pallliative care- (you can guess what to put here).
In home care settings, you are
the defacto Doctor. With some rare (in my experience) exceptions, physicians expect you
to make the ultimate judgement call determining what medications will best benefit your patient at that particular point in the clinical picture (which can change pretty quickly). Physicians and patients alike are placing an enormous amount of trust in confidence in you and you must be ready for this responsibility. Working in an IPU would give you time to mature/ripen into this very different culture of care.
I liken hospice home care to a three-legged stool:
: you must have excellent assessment skills- both physical, cultural, spiritual, psychosocial and emotional (to name a few). For instance: if your patient is experiencing increased episodes of anxiety, you must be able to differentiate the etiology. Is it increased WOB? is it spiritual distress? is their caregiver stressing them out, are they getting any sleep? etc....Hospice is holistic (really, whole
-istic) medicine at it's finest.
: you must have excellent communication skills (read: emotional maturity and tolerance). The psychosocial/therapuedic communication skills in many cases will make or break your enjoyment of your job as a hospice nurse. This is not just in how well you communicate with your patients and their caregivers, it is also how well you communicate with your team and how you talk to yourself
about all that is surrounding you.
: Administrative/attention to detail. You MUST be prepared to spend at least one third
of your total time on paperwork if you work home care. You will have work littered in every corner of your life: your car, your house, your purse etc. You have to be able to document well and on time because this is how your office gets paid (and then is able to pay you). You must also be comfortable with feeling something hanging over your head because there will always be one more thing you need to write out.
I see no reason to continue working med/surg. The truth is that if you decide to take the plunge in any
job change in nursing it will be a new experience that absolutely overwhelms and intimidates you. There are very few truly easy seguays from one specialty of nursing into another. Nursing is too diverse for that. Just expect to be overwhelmed. Expect to feel lost. Expect to question "what on earth was I thinking?!". Because this will be the case with any
change you make in nursing.